What To Expect After Botox For Migraines?

Botox For Migraine What To Expect

Migraine is the most common cause of episodic headache, with an onset before 40 years of age. It is mostly triggered by sensory sensitivity such as light, sound or movement. Frequency of the headache can vary from occasional inconvenience to frequent headaches severely impacting quality of life. Migraine has a typical unilateral throbbing type of pain. Some may have nausea and vomiting associated with the headache.


Some have sleep deprivation, starvation, and stress as triggering factors. There are many treatments available to reduce the pain but the best-recommended treatment option is the avoidance of triggering factors. Where migraine episodes are frequent like 1-2 attacks per month and severely disturbing the quality of life, the patient should be offered migraine suppression medication. Botulinum toxin was a recently recommended prophylaxis treatment for migraine. Patients who are receiving botulinum toxin (Botox injections), should know what to expect after Botox for migraine.


Botox For Migraine - What To Expect?

Botox is only recommended for chronic migraine, which is a headache on 15 or more days a month. It is believed that more frequent headaches, the better the patient does with Botox. Botox contains a toxin called botulinum, which is a neurotoxin produced by Clostridium Botulinum bacterium. This technique involves 31 injections over the scalp and neck repeated every 3 months.

  • The procedure usually takes roughly about 20 minutes, and it is performed by either a headache specialist or a neurologist.
  • The doctor will inject the solution using a needle of 31-32G, which will be very thin.
  • The 13 injections will be injected on to 13 key areas around the head and neck region
  • The time taken for the effects of the injection is an important aspect of what to expect after Botox for migraine. Effect of one treatment lasts for 10-12 weeks, and patients reported that two Botox treatments reduced the number of headache days by approximately 50%. Do not expect the results to show right away, because it usually takes about 6 months to show the maximum benefit.
  • However, if there is no change in the frequency of headaches after 2-3 cycles of Botox injection, the treatment should be discontinued.
  • There are no restrictions in using other regular medication for a headache when the patient is on botulinum toxin.
  • Since Botox is been used for lessening of lines and wrinkles of the face, some patients expect Botox treatment for migraine to make them look younger. But in migraine, the injection sites are different from cosmetic use. Therefore, patients should be clearly educated regarding this matter.

When stating what to expect after Botox for migraine, the side effects of the drug plays a vital role. The effect of botulinum toxin may affect areas away from the injection site and cause various symptoms.

  • There have been reported cases on immediate allergic reactions to the toxin, resulting in itching, rashes. This can go up to difficulty in breathing and anaphylaxis as the most severe form. Therefore, it is contraindicated to use Botox injections on patients who are having known allergy to any compound in the Botox.
  • Pain or discomfort at the injection site is a common side effect experienced by patients. They experience pain in the head and neck area.
  • Patients can develop eye problems like drooping of eyelids, swelling of eyelids, double vision, blurred vision, etc.
  • There is a risk of developing difficulty in swallowing and speaking due to weakening of associated muscles. Swallowing problems may last for several months. If the patient is already having diseases like Lou Gehrig’s disease, Myasthenia Gravis, or Lambert-Eaton Syndrome which are associated with muscle weakness before the injection, he or she is at a higher risk of developing these problems.
  • Some patients can develop high blood pressure after they start Botox injection therapy.

When the side effects of the Botox injection is known in prior hand, the incidence of developing complications can be minimized effectively.


Since Botox injections have shown an effective reduction of headache frequency in migraine, there is a recent increase in the use of this treatment in the medical field. Before starting the treatment, it is necessary to clarify all above-mentioned factors as what to expect after Botox injection to prevent giving patients false expectations. That will improve the patients’ compliance with the therapy and develop patients’ confidence towards the treatment.

Author:

Dr. Chaturi Weerawardana

She pursued her Bachelor of Medicine and Bachelor of Surgery at University of Sri Jayewardenepura currently awaiting her internship.